Margaret McCartney: Hunt’s plan will shame patients who need costly drugsBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3929 (Published 20 July 2015) Cite this as: BMJ 2015;351:h3929
- Margaret McCartney, general practitioner, Glasgow
“This will not just reduce waste by reminding people of the cost of medicine but also improve patient care by boosting adherence to drug regimes,” said Jeremy Hunt.1 Our health secretary wants prescriptions for drugs costing more than £20 (€29; $31) to display the price.
Any politician who dreams up an idea in the bath would be irresponsible not to seek answers to these two key questions: (a) will it work; and (b) what are the harms? Hunt has access to skilled doctors and researchers, but he does not seem to have made any use of them. His plan has had no pilots and no trials—but implementation is happening anyway.
Will it work? Plainly, people who do not value themselves may stop taking drugs that are perceived as expensive. People may decide that they don’t deserve to have their medical costs met. The health secretary may not be aware of this character trait, which is regularly seen by ordinary family doctors.
What are the harms? People may stop taking drugs because of this new information. They may incur preventable diseases, relapses, or complications from disease as a result. People may feel guilt, anxiety, or shame.
Inexplicably, patients won’t be told when their prescription has cost only pennies compared with the £8.20 English prescription charge and, therefore, when they are subsidising others. Nor will they be told how much they generate for the economy or society more broadly by taking drugs that allow them to work for longer or that prevent episodes of illness. And, if drugs have been chosen rather than surgery or another treatment, people will not be told how much this choice has saved the NHS overall.
What of the burden of side effects? People endure obesity, nausea, headaches, or diarrhoea to control mental illness, hypertension, inflammatory bowel disease, or whatever else. This cost to individuals saves the NHS money from treating more severe disease, but it disappears in a simplified drug price tag. Money is the only thing that Hunt wants to count, but the NHS counts for much more.
The health secretary assumes that carelessness and ignorance create costs to the NHS that his scheme can correct. But the NHS works because it is a community pool, a massive shared mutual insurance where we pay for others’ care in order to be assured of the same ourselves. Of course, we must use our resources wisely, but not by playing politics with the NHS to force potentially wasteful activity—with harms unconsidered and uncounted.
Cite this as: BMJ 2015;351:h3929
Competing interests: I have read and understood the BMJ policy on declaration of interests and declare the following interests: I’m an NHS GP partner, with income partly dependent on Quality and Outcomes Framework points. I’m a part time undergraduate tutor at the University of Glasgow. I’ve written two books and earn from broadcast and written freelance journalism. I’m an unpaid patron of Healthwatch. I make a monthly donation to Keep Our NHS Public. I’m a member of Medact. I’m occasionally paid for time, travel, and accommodation to give talks or have locum fees paid to allow me to give talks but never for any drug or public relations company. I was elected to the national council of the Royal College of General Practitioners in 2013 and am chair of its standing group on overdiagnosis. I have invested a small amount of money in a social enterprise, Who Made Your Pants?
Read Tom Moberly’s blog, http://blogs.bmj.com/bmj/2015/07/03/tom-moberly-showing-patients-what-they-are-worth/
Provenance and peer review: Commissioned; not externally peer reviewed.
Follow Margaret on Twitter, @mgtmccartney